Individual
DR. RENATO L TANQUILUT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
14005 RIDGE RD, ORLAND PARK, IL 60462-1824
(708) 460-3072
(773) 277-1166
Mailing address
14005 RIDGE RD, ORLAND PARK, IL 60462-1824
(708) 460-3072
(773) 277-1166
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
01041921A
IN
208600000X
Surgery Physician
Primary
36043550
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000198417
BLUECROSSBLUESHIELD
IN
01
—
0021601990
BLUECROSSBLUESHIELD
IL
Enumeration date
12/18/2006
Last updated
07/08/2007
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